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Bonifacio M, Maheshwari V, Tran D, Agostoni G, Filioussi K, Viana R. Economic Model to Evaluate the Cost-Effectiveness of Second-Line Nilotinib Versus Dasatinib for the Treatment of Philadelphia Chromosome-Positive Chronic Myeloid Leukemia (CML-CP) in Italy. PHARMACOECONOMICS - OPEN 2022; 6:95-104. [PMID: 34297312 PMCID: PMC8807738 DOI: 10.1007/s41669-021-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the cost effectiveness of second-line nilotinib versus dasatinib for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML-CP) patients who are intolerant or resistant to imatinib and can transition to treatment-free remission (TFR). METHODS A partitioned survival model was developed to compare the cost effectiveness of nilotinib versus dasatinib. The model was developed from the Italian healthcare payer perspective and included the following health states: on second-line tyrosine kinase inhibitor (TKI), off second-line TKI, accelerated phase/blastic crisis, TFR, and death. Progression-free and overall survival curves were derived from patient-level data that compared nilotinib and dasatinib as second-line therapy in CML-CP patients who were resistant or intolerant to imatinib. Drug costs, healthcare costs, and adverse event costs were based on real-world evidence and publicly available databases. Cost effectiveness was estimated over a 40-year time horizon. Scenario analyses were performed by adjusting time horizon, TFR parameters, costs, and utilities. RESULTS Second-line nilotinib resulted in greater time spent in TFR (0.91 life-years), increased quality-adjusted life-years (QALYs) (1.89), increased life-years (2.16), and decreased per-patient costs (- 38,760 €). Therefore, nilotinib was strongly dominant compared with dasatinib in the base-case analysis. Nilotinib remained strongly dominant in most scenario analyses including shorter time horizon, exclusion of TFR, and varying TKI drug costs. CONCLUSIONS While the model showed that nilotinib treatment of imatinib-intolerant or resistant CML-CP patients was more effective and less costly than dasatinib treatment, there is considerable uncertainty in the findings.
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Affiliation(s)
| | | | - Diana Tran
- EVERSANA Life Science Services, LLC, Burlington, Ontario, Canada
| | - Gianluca Agostoni
- Region Europe Value and Access, Novartis Farma S.p.A, Origgio, Italy
| | - Kalitsa Filioussi
- Region Europe Value and Access, Novartis Farma S.p.A, Origgio, Italy
| | - Ricardo Viana
- Global Value & Access, Oncology, Novartis Pharma AG, WSJ- Fabrikstrasse 18-3.330, 4056, Basel, Switzerland.
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Maheshwari VK, Slader C, Dani N, Gkitzia C, Yuan Q, Xiong T, Liu Y, Viana R. Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China. PLoS One 2021; 16:e0259076. [PMID: 34695169 PMCID: PMC8544861 DOI: 10.1371/journal.pone.0259076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective. Methods Analyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio. Results Molecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964. Conclusions Overall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.
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Affiliation(s)
| | - Cassandra Slader
- Novartis Pharma AG, Medical Affairs, Basel, Basel Stadt, Switzerland
| | - Nidhi Dani
- Novartis Pharma AG, Value & Access, Basel, Basel Stadt, Switzerland
| | | | - Quan Yuan
- Novartis Oncology, Market Access Strategy, Beijing, China
| | | | - Yu Liu
- Novartis Oncology, Medical Affairs, Beijing, China
| | - Ricardo Viana
- Novartis Pharma AG, Global Value & Access, Oncology, Basel, Basel Stadt, Switzerland
- * E-mail:
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Yamazaki K, Inagaki N, Moldaver D, Viana R, Kimura S. Budget impact analysis of treatment-free remission in nilotinib-treated Japanese chronic myeloid leukemia patients. Cancer Sci 2020; 111:2526-2535. [PMID: 32324296 PMCID: PMC7385357 DOI: 10.1111/cas.14430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 01/05/2023] Open
Abstract
Treatment‐free remission (TFR), in which patients discontinue pharmacotherapy and remain in molecular remission, is an emerging treatment goal for patients with chronic myeloid leukemia (CML). Attainment of TFR requires an increased frequency of molecular monitoring, to ensure that patients maintain a deep molecular response. The objective of this analysis was to assess the economic impact of stopping nilotinib among Japanese TFR‐eligible patients. A Markov model evaluated the economic impact of TFR among the study population, TFR‐eligible CML patients diagnosed since 2012. The model compared patients who had discontinued tyrosine kinase inhibitor (TKI) treatment (ie, attempted TFR) with patients that continued TKI treatment. A 3‐y time horizon was modeled from a Japanese public payer perspective. Costs associated with drug treatment, hospital/physician visits, and molecular monitoring were considered. TFR‐eligible patients were calculated from Japanese CML incidence rates and efficacy was derived from nilotinib trials. Japanese co‐payment maximums were utilized to assess the patient perspective. An estimated 761 and 140 patients were eligible for first‐ and second‐line nilotinib, respectively, in 2019. Assuming that 100% of eligible patients complied, TFR was associated with cost savings of ¥7 625 174 640 (US$66 567 775) over 3 y. In scenarios with reduced willingness to attempt TFR, cost savings persisted. Achievement of TFR was estimated to markedly reduce out‐of‐pocket expenses for CML patients, regardless of the timing of relapse. Stopping nilotinib for TFR‐eligible patients in Japan may result in significant cost savings to both payers and patients. Monitoring costs contributed little to overall annual costs and decreased over time.
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Affiliation(s)
| | | | | | | | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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HDAC6-an Emerging Target Against Chronic Myeloid Leukemia? Cancers (Basel) 2020; 12:cancers12020318. [PMID: 32013157 PMCID: PMC7072136 DOI: 10.3390/cancers12020318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023] Open
Abstract
Imatinib became the standard treatment for chronic myeloid leukemia (CML) about 20 years ago, which was a major breakthrough in stabilizing the pathology and improving the quality of life of patients. However, the emergence of resistance to imatinib and other tyrosine kinase inhibitors leads researchers to characterize new therapeutic targets. Several studies have highlighted the role of histone deacetylase 6 (HDAC6) in various pathologies, including cancer. This protein effectively intervenes in cellular activities by its primarily cytoplasmic localization. In this review, we will discuss the molecular characteristics of the HDAC6 protein, as well as its overexpression in CML leukemic stem cells, which make it a promising therapeutic target for the treatment of CML.
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Gholizadeh F, Ghahremani MH, Aliebrahimi S, Shadboorestan A, Ostad SN. Assessment of Cannabinoids Agonist and Antagonist in Invasion Potential of K562 Cancer Cells. IRANIAN BIOMEDICAL JOURNAL 2019; 23. [PMID: 29883990 PMCID: PMC6707105 DOI: 10.29252/.23.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prominent hallmark of malignancies is the metastatic spread of cancer cells. Recent studies have reported that the nature of invasive cells could be changed after this phenomenon, causing chemotherapy resistance. It has been demonstrated that the up-regulated expression of matrix metalloproteinase (MMP) 2/MMP-9, as a metastasis biomarker, can fortify the metastatic potential of leukemia. Furthermore, investigations have confirmed the inhibitory effect of cannabinoid and endocannabinoid on the proliferation of cancer cells in vitro and in vivo. METHODS In the present study, the inhibitory effect of WIN 55212-2 (a CB1/CB2 receptor agonist) and AM251 (a selective CB1 receptor antagonist) on K562 cells, as a chronic myelogenous leukemia (CML) model, was evaluated using MTT and invasion assay. Expressions of MMP-2 and MMP-9 were then assessed by Western blot analysis. RESULTS The data obtained from MTT assay showed that WIN 55212-2 could attenuate cell proliferation; however, AM251 was less effective in this regard. Our results showed that WIN 55212-2 considerably reduced cancer cell invasiveness, while AM251 exhibited a converse effect. Moreover, CB1 activation resulted in decreased expression of MMP-2 and MMP-9. CONCLUSION Our findings clarifies that CB1 receptors are responsible for anti-invasive effects in the K562 cell line.
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Affiliation(s)
- Fatemeh Gholizadeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Poisoning Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ghahremani
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Poisoning Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Aliebrahimi
- Department of Cellular and Molecular Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Amir Shadboorestan
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Poisoning Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Nasser Ostad
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Poisoning Research Center, Tehran University of Medical Sciences, Tehran, Iran; ,Corresponding Author: Seyed Nasser Ostad , Department of Toxicology and Pharmacology, Faculty of Pharmacy and Poisoning Research Center, Tehran University of Medical Sciences, Tehran, Iran; Tel.: (+98-21) 66959105; E-mail:
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Abstract
Idiosyncratic hepatotoxicity is a leading reason for the discontinuation or dose modification of Food and Drug Administration (FDA)-approved medications in the United States. We report the case of a 53-year-old woman with chronic myeloid leukemia who developed acute cholestatic hepatitis in response to the tyrosine kinase inhibitor nilotinib. Nilotinib was discontinued, and the patient's liver function tests normalized over the next 3 months. We conclude that nilotinib may cause life-threatening hepatotoxicity and recommend that patients on the medication undergo regular monitoring of their liver tests.
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Kafi Z, Cheshomi H, Gholami O. 7-Isopenthenyloxycoumarin, Arctigenin, and Hesperidin Modify Myeloid Cell Leukemia Type-1 (Mcl-1) Gene Expression by Hormesis in K562 Cell Line. Dose Response 2018; 16:1559325818796014. [PMID: 30224905 PMCID: PMC6136114 DOI: 10.1177/1559325818796014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022] Open
Abstract
Hormesis is a new concept in dose–response relationship. Despite of traditional
dose–response curves, there is a low-dose stimulation and a high-dose inhibition
in this case. Hormesis effect in apoptosis induction/inhibition by natural
compounds is reported previously. Here, we searched this effect for myeloid cell
leukemia type-1 (Mcl-1) gene expression by phytochemicals
7-isopenthenyloxycoumarin (7-IP), arctigenin (Arg), and hesperidin (Hsp). For
this purpose, first we tested the cytotoxicity of various doses of these
compounds against K562 leukemia cell lines for different times by
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method. After that
we explored the effect of various doses of these phytochemicals on Mcl-1 gene
expression for different times by real-time polymerase chain reaction method. We
found that these phytochemicals have cytotoxicity against K562 cell line.
Hesperidin is the most cytotoxic agent. We also found that these natural
compounds have hormetic effect on Mcl-1 gene expression. The hormetic model in
Mcl-1 gene expression is overcompensation stimulation. This phenomenon is
reported for the first time. We conclude that 7-IP, Arg, and Hsp are cytotoxic
against K562 cancerous cells and induce/inhibit Mcl-1 gene expression by
hormesis dose–response relationship.
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Affiliation(s)
- Zahra Kafi
- Cellular and Molecular Research Center, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hamid Cheshomi
- Cellular and Molecular Research Center, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Omid Gholami
- Cellular and Molecular Research Center, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Garg L, Akbar G, Agrawal S, Agarwal M, Khaddour L, Handa R, Garg A, Shah M, Patel B, Dalal BD. Drug-induced pulmonary arterial hypertension: a review. Heart Fail Rev 2018; 22:289-297. [PMID: 28417295 DOI: 10.1007/s10741-017-9612-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a subgroup of PH patients characterized hemodynamically by the presence of pre-capillary PH, defined by a pulmonary artery wedge pressure (PAWP) ≤15 mmHg and a PVR >3 Wood units (WU) in the absence of other causes of pre-capillary PH. According to the current classification, PAH can be associated with exposure to certain drugs or toxins such as anorectic agents, amphetamines, or selective serotonin reuptake inhibitors. With the improvement in awareness and recognition of the drug-induced PAH, it allowed the identification of additional drugs associated with an increased risk for the development of PAH. The supposed mechanism is an increase in the serotonin levels or activation of serotonin receptors that has been demonstrated to act as a growth factor for the pulmonary artery smooth muscle cells and cause progressive obliteration of the pulmonary vasculature. PAH remains a rare complication of several drugs, suggesting possible individual susceptibility, and further studies are needed to identify patients at risk of drug-induced PAH.
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Affiliation(s)
- Lohit Garg
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18109, USA.
- , 1250 S. Cedar Crest Blvd, Suite 305, Allentown, PA, 18103, USA.
| | - Ghulam Akbar
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18109, USA
| | - Sahil Agrawal
- Department of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, PA, 18015, USA
| | - Manyoo Agarwal
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
| | - Leila Khaddour
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI, 48073, USA
| | - Rishin Handa
- Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, 48197, USA
| | - Aakash Garg
- Department of Internal Medicine, St. Peter's University Hospital, New Brunswick, NJ, 08901, USA
| | - Mahek Shah
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18109, USA
| | - Brijesh Patel
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18109, USA
| | - Bhavinkumar D Dalal
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI, 48073, USA
- Department of Pulmonary Medicine, Beaumont Health, Royal Oak, MI, 48073, USA
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SCF-KIT signaling induces endothelin-3 synthesis and secretion: Thereby activates and regulates endothelin-B-receptor for generating temporally- and spatially-precise nitric oxide to modulate SCF- and or KIT-expressing cell functions. PLoS One 2017; 12:e0184154. [PMID: 28880927 PMCID: PMC5589172 DOI: 10.1371/journal.pone.0184154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/19/2017] [Indexed: 01/11/2023] Open
Abstract
We demonstrate that SCF-KIT signaling induces synthesis and secretion of endothelin-3 (ET3) in human umbilical vein endothelial cells and melanoma cells in vitro, gastrointestinal stromal tumors, human sun-exposed skin, and myenteric plexus of human colon post-fasting in vivo. This is the first report of a physiological mechanism of ET3 induction. Integrating our finding with supporting data from literature leads us to discover a previously unreported pathway of nitric oxide (NO) generation derived from physiological endothelial NO synthase (eNOS) or neuronal NOS (nNOS) activation (referred to as the KIT-ET3-NO pathway). It involves: (1) SCF-expressing cells communicate with neighboring KIT-expressing cells directly or indirectly (cleaved soluble SCF). (2) SCF-KIT signaling induces timely local ET3 synthesis and secretion. (3) ET3 binds to ETBR on both sides of intercellular space. (4) ET3-binding-initiated-ETBR activation increases cytosolic Ca2+, activates cell-specific eNOS or nNOS. (5) Temporally- and spatially-precise NO generation. NO diffuses into neighboring cells, thus acts in both SCF- and KIT-expressing cells. (6) NO modulates diverse cell-specific functions by NO/cGMP pathway, controlling transcriptional factors, or other mechanisms. We demonstrate the critical physiological role of the KIT-ET3-NO pathway in fulfilling high demand (exceeding basal level) of endothelium-dependent NO generation for coping with atherosclerosis, pregnancy, and aging. The KIT-ET3-NO pathway most likely also play critical roles in other cell functions that involve dual requirement of SCF-KIT signaling and NO. New strategies (e.g. enhancing the KIT-ET3-NO pathway) to harness the benefit of endogenous eNOS and nNOS activation and precise NO generation for correcting pathophysiology and restoring functions warrant investigation.
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